| [Background]Malignant bowel obstruction(MBO)refers to the intestinal obstruction associated with primary or metastatic tumors,and is one of the common complications and causes of death in patients with advanced tumor.Currently,western medicine treatment for MBO includes:fasting for solids and liquids,gastrointestinal decompression,correcting the disturbance of water,electrolyte and acid-base,nutrition support,drug therapy,ileus tube,intestinal-obstruction stent,chemotherapy and surgery.Traditional Chinese medicine for MBO has the characteristic of good curative effect,cheap price,simple operation and less adverse reaction.Traditional Chinese medicine is mainly suitable for the frail patients with advanced tumor or chronic incomplete obstruction who need the palliative and conservative treatment.It is also applied in the integrated traditional Chinese and Western medicine for patients with acute obstruction.Traditional Chinese medicine treatment is mainly divided into enema/anus drops,oral liquid,acupoint application,etc.In the early stage of clinical study,my supervisor successfully cured many patients with MBO by Chinese medicine enema or acupoint application.In recent years,the clinical research literatures on traditional Chinese medicine treatment for MBO have been constantly emerging,most of which reported satisfactory results about the clinical efficacy and safety.But it has not been confirmed by the systematic review.[Objectives]To assess the efficacy and safety of traditional Chinese medicine for malignant bowel obstruction.And to provide evidence for clinical practice according to the systematic review.[Methods]The following databases were searched for review:CNKI;VIP;Wangfang Database;CBM;Medline(PubMed);EMBASE(embase.com);CENTRAL(The Cochrane Library).We collected the clinical RCTs of traditional Chinese medicine in the treatment of MBO according to the search strategies in the plan.Then these literatures were screened according to the inclusion and exclusion criteria.We assessed the methodological quality of the included studies and extracted relevant information from them.Some of the outcome indicators were meta-analyzed by the Revman5.3 software,and the others were just analyzed descriptively.The relevant outcome indicators were explained and discussed.[Results]The systematic review included 2,397 subjects from 40 studies,with 1,221 to the experimental group and 1,176 to the control group.The results of analysis for the outcome indicators are as follows.Total efficiency:36 studies were included(RR=1.37,95%CI[1.30,1.44],P<0.00001).It is suggested that traditional Chinese medicine can improve the efficiency of the conservative and palliative treatment for MBO.It can be recommended to clinical practice with the characteristic of simple operation,low price and high acceptance.Improvement of nausea and vomiting:7 studied reported the indicator.5 studies reported the effect of experimental group was superior to that of control group in the treatment for nausea and vomiting,all by non-oral medicine.Improvement of abdominal pain:5 studies reported the relief time of abdominal pain(SMD=-2.09,95%CI[-2.91,-1.26],P<0.00001);2 studies reported the disappeared time of abdominal pain(MD =-30.57,95%CI[-36.21,-24.93],P<0.00001);2 studies reported NRS scores(MD =-1.98,95%CI[-4.71,0.74],P=0.15);4 studies reported on the efficacy of abdominal pain in other forms,and the conclusion was not consistent.The evidence is of low quality.Improvement of abdominal distention:5 studies reported the relief time of abdominal distention(SMD=-2.65,95%CI[-3.75,-1.56],P<0.0001).The heterogeneity was too large and could not be explained.4 other studies reported on the efficacy of abdominal distension in other forms,and the conclusion was not consistent.The evidence is of low quality.Anal fart and defecation time:Eight studies reported anal fart time(SMD=-1.75,95%CI[-2.48,-1.03],P<0.0001);11 studies reported anal defecation time(SMD=-1.67,95%CI[-2.05,-1.28],P<0.00001).The the evidence is not of high quality,but is still worth recommending for clinical practice.Improvement of diet:2 studies were included.The original data showed that the experimental group was superior to the control group.Quality of life:5 studies reported KPS scores(SMD=0.66,95%CI[0.42,0.88],P<0.00001);6 studies reported KPS improvement rate(RR=1.21,95%CI[1.06,1.39],P=0.005);4 studies reported QOL scores(MD=9.68,95%CI[2.25,17.10],P=0.01),and 1 study reported SF-36 score(T/C:61.9 + 4.9/49.6 + 6.8,P<0.05).It is suggested that traditional Chinese medicine can improve the quality of life of MBO patients,and it is worthy of clinical recommendation.Length of hospital stay:3 studies were included(MD=-3.94,95%CI[-5.02,-2.85],P<0.00001).It is suggested that traditional Chinese medicine can shorten the length of hospital stay in MBO patients for 2-5 days,which is worthy of clinical recommendation.Length of gastric tube stay:3 studies were included(SMD=-2.19,95%CI[-2.65,-1.74],P<0.00001).The evidence is of low quality.Length for X-ray to recover:1 study was included.The original data showed that the experimental group was superior to the control group.Adverse reactions:4 studies were included.By descriptive analysis,it was found that the rate of adverse reactions was low and the symptoms were mild in the Chinese medicine treatment for MBO.[Conclusion]This study shows that traditional Chinese medicine plays a role in the palliative and conservative treatment of MBO,which is worthy of clinical recommendation in improving overall efficiency and quality of life,shortening anal fart or defecation time,and shortening the length of hospital stay.Traditional Chinese medicine can relieve the symptoms of abdominal pain and abdominal distention and shorten the length of gastric tube stay in patients,but the quality of evidence is low.Therefore,these evidence can’t be recommended for clinic with a high degree of certainty.The original research indicated that the treatment of traditional Chinese medicine was safe and effective when it comes to improve nausea,vomiting and diet,to shorten the length for X-ray recovery,and to security.At present,the quality of clinical randomized controlled trials about traditional Chinese medicine for MBO is generally low,and the researchers=ability to conduct clinical trial should be improved so as to provide high-quality raw materials for the evidence users. |
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